Because China is becoming an aging society, the incidence of diabetes and diabetic foot have been increasing. Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates. Negative pressure wound therapy (NPWT) is one of the most effective techniques for the treatment of diabetic foot wounds and great progress, both in terms of research and its clinical application, has been made in the last 20 years of its development. However, due to the complex pathogenesis and management of diabetic foot, irregular application of NPWT often leads to complications, such as infection, bleeding and necrosis, that seriously affect its treatment outcomes. In 2020, under the leadership of Burns, Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association, the writing group for ‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’ was established with the participation of scholars from the specialized areas of burns, endocrinology, vascular surgery, orthopedics and wound repair. Drawing on evidence-based practice suggested by the latest clinical research, this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot. The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

Background and Objectives: There is a lack of multicenter immediate breast reconstruction data comparing the surgical complication of implant and autologous breast reconstruction, especially in China. In this study, we used the data from eight centers to study the complications and their risk factors in this population. Methods: Sociodemographic and clinicopathological data were obtained and compared for patients who received immediate implant and autologous breast reconstruction after breast cancer surgery in the eight hospitals between 2012 and 2016. Logistic regression analysis was used to identify risk factors associated with the complication of breast reconstruction. Results: Immediate autologous reconstruction (IAR) was associated with significantly higher rates of overall complications (P = 0.036), fat liquefaction (P < 0.001), and reconstructive failure (P = 0.019), but lower rates of wound complications (P = 0.01) compared with the immediate implant reconstruction (IIR) at the median follow‐up time of 13.6 months. With the logistic regression analysis, older patient (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.15‐4.28; P = 0.017), and obesity (OR, 2.17; 95% CI, 1.08‐4.37; P = 0.030) were significant predictors of increased complications. Conclusion: Our multicenter results demonstrated that the rates of overall complications and reconstruction failure were higher after IAR than IIR. These findings can be used to better help surgeons and their patients with objective and reliable information to assist in selecting the modality of reconstruction.

Rationale:Retroperitoneal necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease. Here, we present a case of extended retroperitoneal NSTI caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E coli).Patient concerns:The patient complained of progressive redness, swelling, and right flank pain for 10 days, extending to the scrotum for 1 day.Diagnoses:He was admitted with an initial diagnosis of cellulitis.Interventions:Debridement was performed after the scrotum developed necrosis on day 2 of hospitalization. The source of infection was found to be an idiopathic retroperitoneal abscess, which was confirmed by computed tomography. Two consecutive microbiological cultures (aerobic plus anaerobic) of the tissue revealed the presence of ESBL-producing E coli. With the application of negative pressure wound therapy (NPWT), we sutured the wound after consecutive debridement.Outcomes:During the 32 months of follow-up, the patient recovered very well and felt extremely satisfied.Lessons:This case reminds us that ESBL-producing E coli can cause retroperitoneal abscesses, which may induce NSTI. Aggressive debridement and broad-spectrum antibiotics should be administrated immediately when NSTI is suspected, and NPWT is an effective adjuvant therapy for wound closure.

Diabetic peripheral neuropathy (DPN), peripheral artery disease (PAD), and foot deformity are the most common causes of diabetic foot, which can considerably worsen the patient’s quality of life. In this study, we aimed to investigate the prevalence and risk factors associated with DPN, PAD, and foot deformity among patients with diabetes living in Beijing, China. In total, 3,898 diabetes patients from 11 hospitals in Beijing were evaluated using questionnaires and physical examinations, and 3,758 patients were included in the analysis. We compared the demographic, clinical, biological characteristics, and comorbidities of patients with and without DPN, PAD, or foot deformity, and used binary logistic regression analysis to identify potential factors associated with these outcomes. Overall, 882 patients (23.5%) had DPN, 437 patients (11.6%) had PAD, and 1,117 patients (29.7%) had foot deformities, including callus. The risk factors for DPN included: age ≥40 years, a ≥10+year duration of diabetes, a body mass index of &lt;18.5 kg/m2 or ≥24 kg/m2, a systolic blood pressure (SBP) of ≥140 mm Hg, a hemoglobin A1c (HbA1c) level of ≥7%, chronic kidney disease, and cerebrovascular disease. The risk factors for PAD included: a 15+ year diabetes duration, a body mass index of &lt;18.5 kg/m2, a SBP of ≥140 mm Hg, a HbA1c level of ≥7%, chronic kidney disease, coronary heart disease, and cerebrovascular disease. The risk factors for skeletal foot deformities included: women, age ≥40 years, a SBP ≥140 mm Hg, and hyperlipidemia. The risk factors for callus formation included: women, a SBP ≥140 mm Hg, and hyperlipidemia. In conclusion, the prevalence of foot deformities was higher than DPN and PAD in patients with diabetes. Managing the risk factors for DPN, PAD, and foot deformity is important for reducing the risk of diabetic foot.

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